title: Adrenal venous sampling: evaluation of the German Conn's registry.
abstract: In patients with primary aldosteronism, adrenal venous sampling is helpful to distinguish between unilateral and bilateral adrenal diseases. However, the procedure is technically challenging, and selective bilateral catheterization often fails. The aim of this analysis was to evaluate success rate in a retrospective analysis and compare data with procedures done prospectively after introduction of measures designed to improve rates of successful cannulation. Patients were derived from a cross-sectional study involving 5 German centers (German Conn's registry). In the retrospective phase, 569 patients with primary aldosteronism were registered between 1990 and 2007, of whom 230 received adrenal venous sampling. In 200 patients there were sufficient data to evaluate the procedure. In 2008 and 2009, primary aldosteronism was diagnosed in 156 patients, and adrenal venous sampling was done in 106 and evaluated prospectively. Retrospective evaluation revealed that 31% were bilaterally selective when a selectivity index (cortisol adrenal vein/cortisol inferior vena cava) of ≥2.0 was applied. Centers completing <20 procedures had success rates between 8% and 10%. Overall success rate increased in the prospective phase from 31% to 61%. Retrospective data demonstrated the pitfalls of performing adrenal venous sampling. Even in specialized centers, success rates were poor. Marked improvements could be observed in the prospective phase. Selected centers that implemented specific measures to increase accuracy, such as rapid-cortisol-assay and introduction of standard operating procedures, reached success rates of >70%. These data demonstrate the importance of throughput, expertise, and various potentially beneficial measures to improve adrenal vein sampling.
authors.affiliation: Department of Nephrology, Medical Faculty, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Vonend
authors.forename: Nora
authors.initials: N
authors.lastname: Ockenfels
authors.forename: Xing
authors.initials: X
authors.lastname: Gao
authors.forename: Bruno
authors.initials: B
authors.lastname: Allolio
authors.forename: Katharina
authors.initials: K
authors.lastname: Lang
authors.forename: Knut
authors.initials: K
authors.lastname: Mai
authors.forename: Ivo
authors.initials: I
authors.lastname: Quack
authors.forename: Andreas
authors.initials: A
authors.lastname: Saleh
authors.forename: Christoph
authors.initials: C
authors.lastname: Degenhart
authors.forename: Jochen
authors.initials: J
authors.lastname: Seufert
authors.forename: Lysann
authors.initials: L
authors.lastname: Seiler
authors.forename: Felix
authors.initials: F
authors.lastname: Beuschlein
authors.forename: Marcus
authors.initials: M
authors.lastname: Quinkler
authors.forename: Petr
authors.initials: P
authors.lastname: Podrabsky
authors.forename: Martin
authors.initials: M
authors.lastname: Bidlingmaier
authors.forename: Reinhard
authors.initials: R
authors.lastname: Lorenz
authors.forename: Martin
authors.initials: M
authors.lastname: Reincke
authors.forename: Lars Christian
authors.initials: LC
authors.lastname: Rump
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply*; D001800:Blood Specimen Collection / Q000379:methods*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis*; D012042:Registries; D012189:Retrospective Studies; D014680:Veins